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AIDS pandemic may be reversed despite lack of cure

With widespread numbers of HIV patients in treatment, researchers and advocates are talking at this week's International AIDS Conference in Melbourne, Australia, about finally reversing the pandemic. "At this

With widespread numbers of HIV patients in treatment, researchers and advocates are talking at this week's International AIDS Conference in Melbourne, Australia, about finally reversing the pandemic.

"At this point, even without a vaccine and a cure, we have the tools," said Anthony Fauci, an immunologist and long-time head of the National Institute of Allergy and Infectious Diseases. "We can sharply deflect the curve of HIV incidence."

Earlier this month, the World Health Organization recommended that medication should be considered a prevention tool alongside condoms for those at high risk for HIV, the virus that causes AIDS.

Men who have sex with men, sex workers, intravenous drug users, people who are incarcerated and HIV-negative people whose partners are infected should all consider taking the drug Truvada, according to the guidelines, which the World Health Organization discussed Sunday at the conference. The conference used an opening ceremony Sunday to pay tribute to six conference delegates who died aboard Malaysia Airlines Flight 17.

More than 35 million people worldwide are infected with HIV, nearly 12 million of whom have access to medication that has transformed the virus from a death sentence into a chronic disease.

When taken before exposure to the virus, Truvada, made by Gilead Sciences, can effectively prevent infection, said Jim Pickett, director of prevention advocacy at the AIDS Foundation of Chicago.

But only about 4,000 Americans have been prescribed Truvada, since the Food and Drug Administration approved its use for prevention two years ago, Pickett said.

The problem is most doctors and people at highest risk aren't aware of the drug. "I want to see much more saturation of the messaging about this," Pickett said.

AIDS conference organizers hope to raise the profile of this so-called pre-exposure prophylaxis or PrEP approach, and it will be the focus of a number of sessions this week, according to Chris Beyrer, incoming president of the International AIDS Society, which runs the semiannual conference.

Flowers are placed near a sign at the AIDS Conference 2014 in Melbourne on July 22, 2014 as a memorial for those killed onboard Malaysia Airlines flight MH17 after it crashed over rebel-held east Ukraine.(Photo: Esther Lim, AFP/Getty Images)

New York State gave the approach a big push in late June, when Gov. Andrew Cuomo pledged to halt the spread of AIDS in his state, partly through the use of Truvada.

New York plans to use PrEP to help reduce the number of new infections statewide to about 750 per year — down from a high of 15,000 in the early '90s, said Dan O'Connell, director of the AIDS Institute in the New York State Department of Health. "At that point, we would start to see a decrease in prevalence for the very first time (since the AIDS epidemic began)."

Scaling up this approach to the rest of the country and the rest of the world will be a key focus at the conference, said Jen Kates, vice president and director of global health and HIV policy for the Kaiser Family Foundation, speaking before the conference began.

"Implementation of what we know works, particularly for hard-to-reach populations … is where we need to go," she said.